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By fostering resiliency in the health care sector, disruption to the delivery of health care can be minimized in a pandemic. This study’s goal is to evaluate the resilience of the health care system to pandemic influenza by using Greater Vancouver as a case study. The methodological approach is structured around a decision/event tree analysis that computes conditional probabilities of events in an influenza outbreak. Tree branches are partially populated through data procured from semi-structured interviews with ten regional experts. A pandemic influenza scenario was created to provide a specific context to the interview questions. Although the interviews are the primary data source, further information was accumulated through documents such as the British Columbia Pandemic Influenza Preparedness Plan, as well as from a comprehensive review of the existing literature. This event tree allows estimation of the likelihood of certain events occurring in a pandemic, including characteristics such as time, morbidity, and mortality. Additional outcomes include an assessment of the alternative response strategies. This approach is distinctive since prior research on health care has not examined the systems perspective. This perspective allows for a consideration of the entire health care network in a region, including the relationships between each facility and the agencies that govern them. Consequences of the analysis indicate the likelihood of occurrence for four disruption levels, based on the mortality, hospitalizations and stress on the health care system felt in the region. Sensitivity analyses were also conducted to assess the impact of policy decisions. Results suggest that a moderate pandemic event will have a 0.22 – 0.27 probability for causing disruption in the highest two levels, which indicate substantial disruption. Vaccinations were expected to have the greatest impact on reducing virus transmission, if a vaccine is shown to be effective, and made widely available. Three alternative policy options were explored: the All-Mitigations Policy, the Isolation and Social Distancing Policy, and the No Vaccinations Policy. Results indicated a need to further incorporate social distancing and isolation into existing control strategies, and to generate policies and establish agreements to expedite the development and distribution of vaccines in a pandemic’s early phases.

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